<%@ page language="java" contentType="text/html; charset=UTF-8"
	pageEncoding="UTF-8"%>
<%
	String path = request.getContextPath();
	String basePath = request.getScheme() + "://" + request.getServerName() + ":" + request.getServerPort() + path + "/";
%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<base href="<%=basePath%>">
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta http-equiv="pragma" content="no-cache"> 
<meta http-equiv="Cache-Control" content="no-cache,no-store,must-revalidate"> 
<meta http-equiv="expires" content="0"> 
<title>保全变更申请</title>
<meta name="viewport" content="initial-scale=1, maximum-scale=1">
<link rel="stylesheet"
	href="//g.alicdn.com/msui/sm/0.6.2/css/sm.min.css">
<link rel="stylesheet" href="assets/css/rz.css">
<link rel="stylesheet" href="assets/css/LUploader.css">

</head>
<body>
	<div class="page-group">
		<div class="page page-current" id="index">
			<header class="bar bar-nav">
				<h1 class='title'>保全变更申请</h1>
				<a href="policy/policyList" id="back" class="button button-link button-nav pull-left back" external>
					<span class="icon icon-left"></span> 返回
				</a>
			</header>
			
			<div class="content">
				<div class="card">
					<div class="card-header"><b>保单信息</b></div>
					<div class="card-content">
						<div class="list-block contacts-block">
							<div class="list-group">
								<ul>
									<li>
										<div class="item-content">
										<div class="item-inner">
											<div class="item-title label">保单号</div>
											<div class="item-input"><label>411587455214</label></div>
										</div>
										</div>
									</li>
									<li>
										<div class="item-content">
										<div class="item-inner">
											<div class="item-title label">保险金额</div>
											<div class="item-input"><label>10000元</label></div>
										</div>
										</div>
									</li>
									<li>
										<div class="item-content">
										<div class="item-inner">
											<div class="item-title label">投保单位</div>
											<div class="item-input"><label>XX家庭/XX公司</label></div>
										</div>
										</div>
									</li>
									<li>
									<div class="item-content">
										<div class="item-inner">
											<div class="item-title label">保费结算方式</div>
											<div class="item-input"><input type="text" id='paymentTypeOfPremium' placeholder="请选择保费结算方式"/></div>
										</div>
									</div>
									</li>
								</ul>
							</div>
						</div>
					</div>
				</div>
				<div class="content-block-title">申请项目选择</div>
				<div class="card">
					<div class="card-header"><b>信息变更项目</b></div>
					<div class="card-content">
						<div class="list-block">
							<ul>
							  <li>
							    <label class="label-checkbox item-content">
							      <input type="checkbox" name="my-radio">
							      <div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      <div class="item-inner">
							        <div class="item-title-row">
							          <div class="item-title">投保单位信息变更</div>
							        </div>
							      </div>
							    </label>
							  </li>
							  <li>
							    <label class="label-checkbox item-content">
							      <input type="checkbox" name="my-radio">
							      <div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      <div class="item-inner">
							        <div class="item-title-row">
							           <div class="item-title">被保险人信息变更</div>
							        </div>
							      </div>
							    </label>
							  </li>
							  <li>
							    <label class="label-checkbox item-content">
							      <input type="checkbox" name="my-radio">
							      <div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      <div class="item-inner">
							        <div class="item-title-row">
							           <div class="item-title">特别约定变更</div>
							        </div>
							      </div>
							    </label>
							  </li>
							</ul>
						</div>
					</div>
					
				</div>
				<div class="card">
					<div class="card-header"><b>增加被保险人</b></div>
					<div class="card-content">
						<div class="list-block">
							<ul>
							  <li>
									<div class="item-content">
										<div class="item-inner">
											<div class="item-title label">增加人数合计：</div>
											<div class="item-input">
												<input type="text" placeholder="请输入增加的人数" class="">
											</div>
											<div class="item-after">
												<label class="label-switch">
	                							人
              									</label>
											</div>
										</div>
									</div>
								</li>
								<li>
									<div class="item-content">
										<div class="item-title label">申请原因</div>
											<label class="label-checkbox item-content pull-left">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							        		<div class="item-inner">
							        		<div class="item-title-row">
							          			<div class="item-title">新入职 </div>
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      			<div class="item-inner">
							      			<div class="item-title-row">
							          			<div class="item-title">转保 </div>	
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">&nbsp;&nbsp;&nbsp;&nbsp;</label>
									</div>
									<div class="item-content">
											<label class="label-checkbox item-content">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      			<div class="item-inner">
							      				<div class="item-title-row">
							          			其他
							       				</div>
							       				<div class="item-title-row">
							          			<input type="text" placeholder="请输入其他原因">
							       				</div>
							       			</div>
							    			</label>
									</div>
								</li>
							</ul>
						</div>
					</div>
					</div>
					<div class="card">
					<div class="card-header"><b>减少被保险人</b></div>
					<div class="card-content">
						<div class="list-block">
							<ul>
							  <li>
									<div class="item-content">
										<div class="item-inner">
											<div class="item-title label">减少人数合计：</div>
											<div class="item-input">
												<input type="text" placeholder="请输入减少的人数" class="">
											</div>
											<div class="item-after">
												<label class="label-switch">
	                							人
              									</label>
											</div>
										</div>
									</div>
								</li>
								<li>
									<div class="item-content">
										<div class="item-title label">申请原因</div>
											<label class="label-checkbox item-content">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							        		<div class="item-inner">
							        		<div class="item-title-row">
							          			<div class="item-title">离职 </div>
							       			</div>
							       			</div>
							       			</label>
							       			<label class="label-checkbox item-content">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</label>
							       			<label class="label-checkbox item-content">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</label>
							       			
									</div>
									<div class="item-content">
											<label class="label-checkbox item-content">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      			<div class="item-inner">
							      				<div class="item-title-row">
							          			其他
							       				</div>
							       				<div class="item-title-row">
							          			<input type="text" placeholder="请输入其他原因">
							       				</div>
							       			</div>
							    			</label>
									</div>
								</li>
							</ul>
						</div>
					</div>
				</div>
				<div class="card">
					<div class="card-header"><b>保障变更</b></div>
					<div class="card-content">
						<div class="list-block">
							<ul>
							  <li>
							  	<div class="item-content">
											<label class="label-checkbox item-content pull-left">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							        		<div class="item-inner">
							        		<div class="item-title-row">
							          			<div class="item-title">增加保额 </div>
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      			<div class="item-inner">
							      			<div class="item-title-row">
							          			<div class="item-title">减少保额 </div>	
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">&nbsp;&nbsp;&nbsp;&nbsp;</label>
								</div>
							  </li>
							  <li>
							  	<div class="item-content">
											<label class="label-checkbox item-content pull-left">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							        		<div class="item-inner">
							        		<div class="item-title-row">
							          			<div class="item-title">增加附约 </div>
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      			<div class="item-inner">
							      			<div class="item-title-row">
							          			<div class="item-title">减少附约 </div>	
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">&nbsp;&nbsp;&nbsp;&nbsp;</label>
								</div>
							  </li>
							  <li>
							  	<div class="item-content">
											<label class="label-checkbox item-content pull-left">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							        		<div class="item-inner">
							        		<div class="item-title-row">
							          			<div class="item-title">月薪变更 </div>
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      			<div class="item-inner">
							      			<div class="item-title-row">
							          			<div class="item-title">层级调整 </div>	
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">&nbsp;&nbsp;&nbsp;&nbsp;</label>
								</div>
							  </li>
							</ul>
						</div>
					</div>
				</div>
				<div class="card">
					<div class="card-header"><b>保单退保</b></div>
					<div class="card-content">
						<div class="list-block">
							<ul>
							  <li>
									<div class="item-content">
										<div class="item-inner">
											<div class="item-title label">退保原因：</div>
											<div class="item-input">
												<textarea placeholder="请输入退保原因"></textarea> 
											</div>
										</div>
									</div>
								</li>
							</ul>
						</div>
					</div>
				</div>
				<div class="card">
					<div class="card-header"><b>犹豫期退保</b></div>
					<div class="card-content">
						<div class="list-block">
							<ul>
							  <li>
									<div class="item-content">
										<div class="item-inner">
											<div class="item-title label">退保原因：</div>
											<div class="item-input">
												<textarea placeholder="请输入退保原因"></textarea> 
											</div>
										</div>
									</div>
								</li>
							</ul>
						</div>
					</div>
				</div>
				<div class="card">
					<div class="card-header"><b>其他项目</b></div>
					<div class="card-content">
						<div class="list-block">
							<ul>
								<li>
									<div class="item-content">
											<label class="label-checkbox item-content pull-left">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							        		<div class="item-inner">
							        		<div class="item-title-row">
							          			<div class="item-title">保单挂失补发 </div>
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      			<div class="item-inner">
							      			<div class="item-title-row">
							          			<div class="item-title">批量补发 </div>	
							       			</div>
							       			</div>
							    			</label>
							    			<label class="label-checkbox item-content">&nbsp;&nbsp;&nbsp;&nbsp;</label>
									</div>
									<div class="item-content">
											<label class="label-checkbox item-content">
							      			<input type="checkbox" name="my-radio">
							     			<div class="item-media"><i class="icon icon-form-checkbox"></i></div>
							      			<div class="item-inner">
							      				<div class="item-title-row">
							          			其他
							       				</div>
							       				<div class="item-title-row">
							          			<input type="text" placeholder="请输入其他项目">
							       				</div>
							       			</div>
							    			</label>
									</div>
								</li>
							</ul>
						</div>
					</div>
					</div>
					<div class="content-block-title"></div>
					<div class="card">
					<div class="card-header"><b>具体描述</b></div>
					<div class="card-content">
						<div class="list-block">
							<ul>
							  <li>
									<div class="item-content">
										<div class="item-inner">
											<div class="item-input">
												<textarea placeholder="请在此详细填写申请原因及相关变更信息"></textarea> 
											</div>
										</div>
									</div>
								</li>
							</ul>
						</div>
					</div>
				</div>
				<div class="card">
					<div class="card-header"><b>保障变更</b></div>
					
					<div class="card-content">
						<div class="list-block">
							<ul>
							  <li>
									<div class="item-content">
										<div class="item-inner">
											<div class="label">1、 增加的被保险人中是否有目前尚在病假或无法正常上班？（选中为是，不选为否）</div>
											<div class="item-after">
												<label class="label-switch">
	                								<input id="checkbox2" type="checkbox">
	               						 			<div class="checkbox"></div>
              									</label>
											</div>
										</div>
									</div>
								</li>
								<li>
									<div class="item-content">
										<div class="item-inner">
											<div class="label">2、增加的被保险人中是否有在近一年内因患病而不能全勤工作或减轻劳动量？（选中为是，不选为否）</div>
											<div class="item-after">
												<label class="label-switch">
	                								<input id="checkbox2" type="checkbox">
	               						 			<div class="checkbox"></div>
              									</label>
											</div>
										</div>
									</div>
								</li>
								<li>
										<div class="item-content">
											<div class="item-inner">
												<div class="col-100">
													<label style="font-size: x;">注意：若有任一被保险人（含附属）存在上述情况，请选中并提供 《团险被保人告知声明书》，否则请不要选中。</label>
												</div>
											</div>
										</div>
									</li>
							</ul>
						</div>		
					</div>
				</div>
					
				<div class="content-block">
					<div class="row">
						<div class="col-100">
							<a href="policy/policyList" class="button button-big button-fill button-success" external>申&nbsp;&nbsp;&nbsp;&nbsp;请</a>
						</div>
					</div>
				</div>
				
				<%@ include file="/include/footer.jsp"%>
			</div>

		</div>

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	<script src="assets/js/LUploader.js"></script>
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	<script type="text/javascript">
		
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